AU2018218257A1

AU2018218257A1 - Intraocular lens inserter cartridge with an iol-guiding structure

Info

Publication number: AU2018218257A1
Application number: AU2018218257A
Authority: AU
Inventors: Ilya Goldshleger; Hoang Nguyen
Original assignee: RxSight Inc
Current assignee: RxSight Inc
Priority date: 2017-02-07
Filing date: 2018-02-07
Publication date: 2019-07-25
Also published as: CA3048023A1; US11083568B2; CN110290762A; BR112019013187A2; EP3547960A1; JP2020505185A; EP3547960A4; US20180221142A1; WO2018148228A1

Abstract

A cartridge of an intraocular lens inserter comprises an insertion nozzle, having a distal insertion channel; an infra-ocular lens (IOL)-folding stage, to receive and to fold an IOL, prox imal to the insertion nozzle, and having a proximal insertion channel; and an SOL-guIding structure. The iOL-guiding staicture can inckde a first proximal guiding groove, or a first proximal guiding rib, or both, formed in the lOL-foiding stage. An intraocular leas inserter comprises an inserter cylinder; a push-rod, partially in the inserter cylinder: a cartridge- receiving insertion end, to receive a cartridge that includes an insertion nozzle, having a distal insertion channel; an iOL-faidiog stage, proximal to the insertion nozzle, having a proximal insertion channel; and an lOL-guiding structure.

Description

INTRAOCULAR LENS INSERTER CARTRIDGE

WITH AN IOL^GUIDING STRUCTURE

TECHNICAL FIELD [00011 This invention relates to intraocular lens inserters, and more specifically to guiding structures in the cartridges for intraocular lens inserters.

BACKGROUND [0002] The techniques of cataract surgery are experiencing continuous, impressive progress. Subsequent generations of phacoemulsification platforms and newly invented surgical lasers keep increasing the precision of the placement of intraocular lenses- (lOLs), and keep reducing the unwanted medical outcomes.

[0003] In a typical cataract procedure, an TOL is placed and folded into a cartridge, which is then placed into a tip of an inserter. Subsequently, a nozzle of the cartridge at the tip of the inserter is inserted into an eye through a surgically created i ncision, reaching the capsule of die eye. Then the IOL is pushed out of the cartridge through an insertion channel by a push-rod into the eye-capsule, where it is positioned, oriented, and rotated according to the pre-surgical plan, and then stabilized.

[0004] The more precisely the IOL is placed in the eye-capsule, the better the medical outcome. The precisi on placement of the IOL invol ves placing the IOL to the planned location with the planned orientation, as determined during the pre-surgical planning process. This is especially important for high-end tone, diffractive, and aspheric lOLs, whose optical axes need to be aligned with the planned orientation within a few degrees to achieve the planned and promised vision correction.

[0005] In a typical cataract procedure, in order to minimize the length of the incision, the insertion nozzle of the cartridge is tapered and its diameter is made as small as possible. To make the IOL able to pass through this narrow and tapered insertion nozzle, the IOL is folded up and compressed substantially when it is placed into the cartridge. The gain associated with the narrowness of the insertion nozzle and the shortness of the incision, however, comes at a price, as the heavily compressed IOL tends to rotate while it is pushed through the tapered nozzle. Because of this rotation, the orientation of the IOL, and its haptics, after insertion often deviates from the surgically planned orientation. This is an undesirable outcome that midermines the medical benefit of tire cataract procedure, especially when involving advanced lOLs, such as toric, diffractive, and aspheric lOLs, and any other intraocular lens designs, for

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PCT/US2018/017143 which the orientation of the IOL or its haptic is important. Therefore, there is a profound need to reduce and potentially eliminate the rotation of the IOL as it is pushed along the insertion nozzle.

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SUMMARY [0006] The above-described medical needs can be met by a cartridge of an intraocular lens inserter that comprises an insertion nozzle, having a distal insertion channel; an intra-ocular lens (lOL)-folding stage, to receive and to fold an IOL, proximal to the insertion nozzle, and having a proximal insertion channel; and an lOL-guiding structure, The lOL-guiding structure can include a first proximal guiding groove, or a first proximal guiding rib, or both, formed in the IOL~folding stage. In some embodiments, an intraocular lens inserter comprises an inserter cylinder; a push-rod. partially in the inserter cylinder; a cartridge-receiving insertion end, to receive a cartridge that includes an insertion nozzle, having a distal insertion channel; an IOLfolding stage, proximal to the insertion nozzle, having a proximal insertion channel; and an lOL-guiding structure.

BRIEF DESCRIPTION OF THE DRAWINGS [0007] FIG. 1 illustrates an inserter 100.

[0008] FIG. 2 illustrates an inserter 100 with a cartridge 200, [0009] FIG. 3 illustrates an IOL 10 loaded into a cartridge 200.

[0010] FIG. 4 illustrates a perspective view of a cartridge 200 from a proximal front.

[0011] FIGS. 5A-B illustrate perspective views of a cartridge 200.

[0012] FIG. 6 illustrates a longitudinal cross section of a cartridge 200, [0013] FIG. 7 illustrates an open cartridge 200 with an IOL 10 loaded.

[0014] FIG. 8 illustrates a cartridge 200 with an IOL 10 during the folding process, [0015] FIGS. 9A-B illustrate a cartridge 200 with a folded IOL 10, pushed by a push-rod 110.

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DETAILED DESCRIPTION

10016] This document describes embodiments of ophthalmic inserters and their cartridges that provide improvements regarding the above described medical needs.

[0017] FIG. 1 illustrates an inserter 100 for use in cataract surgeries to insert an intraocular lens (IOL) 10 into the capsule of an eye through an incision made by the surgeon . The main components of the inserter 100 include a push-rod 110, an inserter cylinder 120, and a cartridge-receiving tip 130. Some inserters 100 are re-usable, others are use-once disposable devices. Reusable inserters 100 can be made of titanium or other suitable metal or plastic, and can be autoclavable.

[0018] A typical use of the inserter 100 can include the following steps (1} The IOL 10 is placed, or loaded, and then folded into a cartridge 200, (2) The cartridge 200 is positioned into the cartridge-receiving tip 130 of the inserter 100. (3) A distal tip, or insertion nozzle, of the cartridge 200 is inserted into an eye through an incision, created earlier by the surgeon. (4) FIGS. 2 and 3 show that after the insertion of the distal tip of the cartridge 200 into the eye, the IOL 10 is pushed forward by advancing the push rod 110. The IOL 10 is eventually ejected from the cartridge 200 and thus gets inserted from the cartridge 200 into the eye. The push-rod 110 can be advanced by turning a screw, as shown, or by direct pushing, or by a variety of other known mechanical solutions. In some embodiments, the inserter cylinder 120 can be referred to as a main body, and the cartridge-receiving tip 130 can be referred to as, or include, a cover.

[0019] As discussed earlier, there are clear medical benefits associated with inserting the IOL 10 into the capsule of the eye with a preferred, or predetermined, alignment and orientation. It is noted that it is not sufficient to load the 101.. 10 into the cartridge 200 with the planned orientation, because the IOL 10 can, and often does rotate away from its preferred orientation as it is pushed through the small diameter distal end of the cartridge 200 by the push rod 110. This can lead to undesirable medical outcomes, such as the misalignment of the major meridians of an implanted toric IOL with the axis of astigmatism of the eye. This issue is of substantial importance, as even a few degree misalignment of a toric lens from a planned direction can lead to substantial discomfort for the patient. It is a recurring event that even a seemingly small misalignment is so bothersome that some patients ask for a second procedure to rotate the IOL, or possibly even to remove the IOL from the eye altogether. Especially in “patient-pay” procedures that promise high quality outcomes, such a surgical result is highly undesirable.

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PCT/US2018/017143 |0020] Embodimen ts of the here-described cartridge 200 are designed to reduce, to restrain, to minimize and possibly to eliminate this undesirable IOL rotation during the insertion process.

|0021| FIGS. 4-9B illustrate embodiments of the cartridge 200 that include an insertion nozzle 210, having a distal insertion channel 220-d; an intraocular ophthalmic lens (IOL)~ folding stage 230, proximal to the insertion nozzle 210, having a proximal insertion channel 220~p; and an lOL-guidmg structure 240. In some detail FIGS. 4-6 describe the structure of embodiments of the cartridge 200 from different perspectives, and FIGS. 7-9 B illustrate the loading of the IOL 10 into the cartridge 200, and the insertion of the IOL 10 from different perspectives and at different stages. The below description focuses on the various embodiments and variants of the lOL-guiding structure 240.

[00221 FIG. 4 shows that in some embodiments, the lOL-guiding structure 240 can include a first proximal guiding groove 240g-pl, formed in the IOL-folding stage 230. This first proximal guiding groove 240g-pl can guide the IOL 10 during its insertion and restrain its rotation, as described below in detail. In the. description below, the labels “p” and “d” typically refer to an element being “proximal” or “distal”. Further, in the Figures, the terms “first” and “second” are represented only by the added labels “1” and “2”, respectively.

[0023] The lOL-guiding structure 240 can further include a second proximal guiding groove 240g-p2, also formed in the IOL folding stage 230, and a first distal guiding groove 240g~d.l, formed distal to the IOL folding stage 230. In some embodiments, the first distal guiding groove 240g-dl is formed as part of the insertion nozzle 210. In others, the first distal guiding groove 240g-dl can be formed distal to the IOL folding stage 230, but proximal to the insertion nozzle 210, as shown in FIG. 6. The guiding grooves 24()g-dl, 240g~pl and 240g-p2 together will be referenced as guiding grooves 240g. Each of these guiding grooves can guide the IOL 10 during insertion, and restrain its rotation. While FIG. 4 only shows one distal guiding groove 240g-dl, some embodiments may include an additional distal guiding groove 240g-d2, not shown explicitly.

[00241 The IOL-folding stage 230 can include a foldable IOL-folding wing 231, to partially receive the IOL 10, and a fixed IOL-folding wing 232, to partially receive the IOL 10. In some embodiments, the first proximal guiding groove 240g-pI can be formed in the foldable IOLfolding wing 231, in other embodiments, in the fixed IOL-folding wing 232, or partially in both. In the illustrated examples, the first proximal guiding groove 240g-pl will be shown formed in the foldable IOL-folding wing 231, but the mirrored embodiments, in which the first

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PCT/US2018/017143 proximal guiding groove 240g-pl is formed in the fixed lOL-fblding wing 232 are also used in other embodiments.

[0025] In embodiments that have both the first proximal guiding groove 240g-pi, and the second proximal guiding groove 240g~p2, the first proximal guiding groove 240g-pl can be formed in the foldable lOL-fblding wing 231, and the second proximal guiding groove 240gp2 can be formed in the fixed lOL-fblding wing 232, so that both IOL-folding wings 23I and 232 have a proximal guiding groove 240g-pl or 240g-p2, The fixed lOL-folding wing 232 can be fixed relative to the insertion nozzle 210.

[0026] FIGS. 4, 5B, and 9A-B show that in some embodiments, the proximal insertion channel 220-p is formed or defined by a first proximal insertion channel 220-pl in the foldable lOL-fblding wing 231 and by a second proximal insertion channel 220-p2 in the fixed IOLfolding wing 232, when the foldable IOL-folding wing 231 is clasped or attached to the fixed lOL-folding wing 232 with a clasp 270.

[0027] FIG. 7 illustrates that when the IOL 10 is loaded into the cartridge 200. it is positioned onto the foldable lOL-folding wing 231 and onto the fixed lOL-folding wing 232, over the first and second proximal insertion channels 220-pl and 220-p2. The foldable 1OLfolding wing 231 and the fixed IOL-folding wing 232 are in this sense configured to partially receive the IOL 10.

[0028] A leading function of the guiding grooves 240g is to guide the IOL 10 during insertion, thus restraining and reducing an unintended rotation of the IOL 10. In some detail, the first proximal guiding groove 240g-p1 can be configured to catch an edge of the IOL 10 and then guide this edge during the insertion of the IOL 10, thereby restraining a rotation of the IOL 10 as it moves along the proximal insertion channel 220-p. To make the guiding firmer, embodiments of the cartridge 200 may include the second proximal guiding groove 240g-p2 that catches an opposite edge of the IOL 10. Such embodiments of the cartridge 200 can provide a firmer guidance and constrain the IOL 10 more efficiently from rotating during insertion. Some embodiments of the guiding grooves 240g can reduce, restrain, or constrain the rotation of the IOL 10 particularly efficiently. These embodiments can minimize and even prevent a rotation of the IOL 10 during insertion. The IOL 10 being round, an edge of the IOL 10 typically refers- to a short first segment of the circular perimeter of the IOL 10, and an opposite edge can refer to a short second, segment that is diagonally opposite to the first segment.

[0029] FIGS. 7-9A illustrate that the proximal guiding grooves 240g-p (referring to the first and second proximal guiding grooves 240g-p1 and 240g~p2) can have more than one function. In some embodiments, the first proximal guiding groove 240g-pl, or the second

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PCT/US2018/017143 proximal guiding groove 240g-p2, or both, can be configured to also help folding the IOL 10 by catching an edge of the IOL 10 as part, of the folding process. Indeed, in some typical cases, the loading of the IOL 10 can start with simply placing the IOL 10 on, or over, the two semicylinders of the first and second proximal insertion channels 220-p'l and 220-p2. Then, an opera tor can start folding the foldable IOL-folding wing 231. Without a mechanical constraint, or restraining force, the IOL 10 may pop out, or slide out, from the proximal insertion channels 220~pl and 220~p2, preventing the controlled folding of the IOL 10. This challenge can be brought under control by the proximal guiding groove 240g-pl, or 240g-p2, or both, catching an edge of the IOL 10. and thus preventing a pop-out, or slide-out, thereby enabling a wellcontrolled folding of the IOL 10. An initial stage of the IOL folding is shown in FIG. 7, an intermediate stage of the folding is shown in FIG. 8, and the end of the folding is shown in FIG. 9A.

(0030( FIG. 6 illustrates that some of the embodiments of the cartridge 200 can also have a first distal guiding groove, 240g-dL The first distal guiding groove 240g-dl can be formed distally to the IOL folding stage 230. The first distal guiding groove 240g-dl is sometimes formed in the insertion nozzle 210. FIG. 6 shows that in some other designs, the cartridge 200 may include a short intermediate segment, distal to the lOL-folding stage 230, but proximal to the insertion nozzle 210. In such designs, the first distal guiding groove 240g-dI can be formed in this intermediate segment, essentially as a continuation of the first proximal guiding groove 240g~p.L The first distal guiding groove 240g-dl can be configured to guide an edge of the IOL 10 during an insertion of the IOL into an eye, thereby restraining a rotation of the IOL 10 as it moves along the distal insertion channel 220-d.

(0031] In some designs, the second proximal guiding groove 240g-p2, that is formed in the fixed IOL folding wing 232, can be longer than the first proximal guiding groove 240g~p l. In the embodiment of FIG. 6, the second proximal guiding groove 240g-p2 is as long as the first proximal guiding groove 240g-pl and the corresponding first distal guiding groove 240g-d'l combined. The end-portion of the second proximal guiding groove 240g-p2, parallel with the first distal guiding groove 240g-dl can be nominally called a second distal guiding groove 240g~d2, but structurally, this end-portion is simply a continuation of the second proximal guiding groove 240g-p2 in some embodiments.

(0032] In some embodiments, the first distal guiding groove 240g-dl can be aligned with the first proximal guiding groove 240g-pl. In such embodiments, the guided edge of the IOL 10 can smoothly pass from the first proximal guiding groove 240g~pI io the first distal guiding

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220-p into the distal insertion channel 220-d.

[0033] FIG, 6 also illustrates that the guiding grooves can end in a tapered manner, since the entire IOL 10 needs to get compressed as it advances toward the narrower and tapered insertion nozzle 210 during insertion. The aligned first guiding grooves 240g-p l/240g-dl can end with a tapered end of the guiding groove 241-1, and the second proximal guiding groove 240g~p2 can end with a tapered end of guiding groove 241-2. The second proximal guiding groove 240g-p2 can extend beyond the IOL folding stage 230, so that its tapered end 241-2 can align with the tapered end 241 -1 of the aligned first guiding grooves 240g~p 1 /240g-d I. One of the reasons for the tapered design is that the insertion nozzle 210 itself can be tapered, its outer diameter decreasing to smaller and smaller values towards its distal tip, so that it can fit into the incision made by the surgeon. In typical cataract surgeries, the incision can be 2.5-3 mm long and accordingly the outer diameter of the distal tip of the insertion nozzle 210 can be reduced to the range of G3 mm. In some embodiments, the outer diameter of the insertion nozzle can be in the 1-2 .mm range.

[0034] FIGS. 9A-B illustrate an early stage and a later stage of the insertion of the IOL 10. FIG. 9A shows a folded IOL 10 inside the lOL-folding stage 230 of the cartridge 200 after the folding has been completed. For clarity, in this cut-away drawing, only the inner walls ofthe cartridge 200 are shown, forming the proximal insertion channel 220-p and the distal insertion channel 220-d. FIG. 9A shows the stage ofthe IOL insertion when the push-rod 110 is pushing the IOL 10 from the proximal insertion channel 220-p into the distal insertion channel 220-d. FIG. 9B shows the stage when the IOL 10 has been largely pushed into the distal insertion channel 220-d. Visibly, the guiding grooves 240g managed to reduce and constrain the rotation ofthe IOL 10 during these stages ofthe insertion.

[0035] Next, another embodiment of the IOL-guiding structure 240 will be described. FIGS. 4 and SB illustrate that in some embodiments, the IOL-guiding structure 240 can include a first proximal guiding rib 240r-pI, formed in the lOL-folding stage 230, to protrude into the proximal insertion channel 220-p.

[0036] As before, in some embodiments, the lOL-folding stage 230 can include the foldable lOL-folding wing 231, to partially receive the IOL 10, and the fixed lOL-folding wing 232, to partially receive the IOL 10. In some embodiments, the first proximal guiding rib 240rpl can be formed in the foldable IOL-folding wing 231. In others, the first proximal guiding rib 240r-pl can be formed in the fixed lOL-folding wing 232. In the illustrated examples, the first proximal guiding rib 240r-pl will be shown formed in the foldable lOL-folding wing 231,

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PCT/US2018/017143 but the mirrored embodiments, in which the first proximal guiding rib 240r-pl is formed in the fixed IOL-foIding wing 232 are also used in other embodiments.

[0O37| As shown in FIG. SB, the foldable lOL-foldiag wing 231 and the fixed IOL-foIding wing 232 can form the proximal insertion channel 220-p when the foldable IOL-folding wing 231 is clasped or attached to the fixed IOL-folding wing 232 with clasp 270.

10038] Some embodiments can include two proximal guiding ribs 240r-p: the first proximal guiding rib 240r~pl, formed in the foldable IOL-folding wing 231, and a second proximal guiding rib 240r-p2, formed in the fixed IOL-folding wing 232, so that both IOL-foIding wings 231 and 232 have a proximal guiding rib 240r~pl and 240r-p2.

[0039] FIG. 5B and FIG. 6 illustrate that some embodiments of the cartridge 200 can also include a first distal guiding rib 240r-dl, formed distally from the lOL-fblding stage 230. In some embodiments, the first distal guiding rib 240r-dI can be formed distally to the IOL folding stage 230. In the embodiment of FIG. 6, the first distal guiding rib 240r-dl is formed in die insertion nozzle 210. FIG. 0 shows that in some other designs, the cartridge 200 may include a short intermediate segment, distal to the IOL-folding stage 230, but proximal to the insertion nozzle 210. In some designs, not shown, the first distal guiding rib 240r-dI can be at least partially formed in this intermediate segment. The first distal guiding rib 240r-dl can be configured to guide an edge of the IOL 10 during an insertion of the IOL into the eye, thereby restraining a rotation of the IOL 10 as it mo ves along the distal insertion channel 220-d. While FIGS. SB and FIG. 6 only show one distal guiding rib 240r-dl, some embodiments may include an additional distal guiding rib 240r-d2, not shown explicitly.

|OO40] A leading function of the guiding ribs 240r-pl, 240r«p2_} and 240r~dl is to guide an edge of the IOL 10 during insertion. In some detail, the guiding ribs 240r-pl, 240r-p2, and 240r~dl can be configured to protrude into the proximal insertion channel 220-p, and into the distal insertion channel 220-d to guide an edge of the IOL 10 during the IOL insertion, thereby reducing and restraining a rotation of the IOL 10 as it is pushed forward by the push rod 110 during insertion.

[0041] FIG. 8 iii ustrates that in some embodiments, the proximal guiding ribs 240r-pl and 240r~p2 can have the additional function of helping the folding of die IOL 10 by catching an edge of the IOL 1,0 as part of the folding process. As before, FIG. 7 shows the beginning of the process of folding the IOL 10, when the flat IOL 10 is placed on the foldable IOL-folding wing 231 and the fixed IOL-folding wing 232, both partially receiving the IOL 10. FIG. 8 illustrates an intermediate stage of the folding, where the first and second proximal guiding ribs 240r-pl and 240r~p2 each caught an edge of the IOL 10, and thus control the folding of

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PCT/US2018/017143 the IOL 10 as the foldable IOL-folding wing 231 is folded in. FIG. 9A illustrates the advanced folding stage when the IOL 10 has been completely folded, [00421 In embodiments that include both the first proximal guiding rib 240r-p 1 and the first distal guiding rib 240r-dl, the first distal guiding rib 240r-dl can be aligned with the first proximal guiding rib 240r-pl. In such embodiments, the caught edge of the IOL 10 can smoothly pass from the first proximal guiding rib 240r-pl to the first distal guiding rib 240rd l as the push-rod I10 advances the IOL 10 from the proximal insertion channel 220~p to the distal insertion channel 220-d.

[0043] FIG. 6 illustrates that in some other embodiments that include both the first proximal guiding rib 240r-p I and the first distal guiding rib 240r-dl, the first distal guiding rib 240r~dl may not be aligned with the first proximal guiding rib 240r-pI. In such embodiments, the caught edge of the IOL 10 turns with a predetermined, preferred angle as it passes from the first proximal guiding rib 240r-pl to the first distal guiding rib 240r-dl as the push-rod 110 advances the IOL 10 from the proximal insertion channel' 220-p to the distal insertion channel 220-d, This planned rotation of the IOL 10 may be dictated, or preferred, by mechanical considerations of the inserti on process, or by medical considerations, to make the IOL 10 reach its most preferred orientation, [0044] FIG, 6 illustrates that the first distal guiding rib 240r-d l can be tapered, ending part way in the insertion nozzle 21.0. As before, one reason for this design can be that the entire insertion nozzle 210 is tapered, thus it is beneficial to reduce and phase out the protruding first distal guiding rib 240r-dl as the IOL 10 gets ever more compressed in the ever more cramped space of the tapered insertion nozzle 210.

[0045] Finally, the lOL-guiding structure 240 can have other embodiments that combine the above designs. These embodiments may include one or more guiding grooves 240g-pl, 240g-p2, and 240g-dl, and one or more guiding ribs 240r-pl, 240r-p2. and 240r-dl in various combinations. Having both guiding grooves 240g and guiding ribs 240r can make the overall lOL-guiding structure 240 more efficient in achieving its main function of reducing or controlling die rotation of the IOL 10 during insertion, as well as achieving its additional functions, such as assisting the IOL folding process.

[0046] While this document contains many specifics, details and numerical ranges, these should not be construed as limitations of the scope of the invention and of the claims, but, rather, as descriptions of features specific to particular embodiments of the invention. Certain features that are described in this document in the context of separate embodiments can also be implemented in combination in a single embodiment. Conversely, various features that are

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PCT/US2018/017143 described in the context of a single embodiment can also be implemented in multiple embodiments separately or in any suitable subcombination. Moreover, although features .may be described above as acting in certain combinations and even initially claimed as such, one or more features, from a claimed combination can in some cases'be excised from the combination, and the claimed combination may be directed to another subcombinaiion or a variation of a subcombinations.

Claims

PCT/US2018/017143

1. A cartridge of an intraocular lens inserter, comprising:

an insertion nozzle, having a distal insertion channel;

an intra-ocular lens (IOL)-fblding stage, to receive and to fold an IOL, proximal to the insertion nozzle, and having a proximal insertion channel; and an lOL-guiding structure,
2. The cartridge of claim 1., the lOL-guiding structure comprising;

a first proxitrial guiding groove, formed in the IOL-folding stage,
3. The cartridge of claim 2, the lOL-folding stage comprising:

a fixed lOL-folding wing, to partially receive the IOL; and a foldable lOL-folding wing, to partially receive the IOL, wherein the first proximal guiding eroove is formed in at least one of the fixed IOL-folding

1 X·' X·' W‘ JX·· wing and the foldable lOL-folding wing.
4. The cartridge of claim 3, wherein:

the fixed IOL-folding wing and the foldable lOL-fokitng wing form the proximal insertion channel when the foldable lOL-folding wing is attached to the fixed lOL-folding wing.
5. The cartridge of claim 3, comprising:

a. second proximal guiding groove, formed so that the fixed IOL-folding wing and the foldable IO [.-folding wing each have one of the first proximal guiding groove and the second proximal guiding groove.
6. The cartridge of claim 2, wherein:

the first proximal guiding groove is configured to guide an edge of the IOL during an insertion of the IOL into an eye, thereby restraining a rotation of the IOL as it moves along the proximal insertion channel.
7. The cartridge of claim 2, wherein:

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PCT/US2018/017143 the first proximal guiding groove is configured to catch an edge of the IOL as part of a folding of the IOL.
8. The cartridge of claim 2, comprising:

a first distal guiding groove, formed distal to the IOL folding stage.
9. The cartridge of claim 8, wherein:

the first distal guiding groove is aligned with the fust proximal guiding groove.
10. The cartridge of claim 8, wherein:

the first distal guiding groove is configured to guide an edge of the IOL during an insertion of the IOL into an eye, thereby restraining a rotation of the IOL as it moves along the distal insertion channel.
11. The cartridge of claim 1, the lOL-guiding structure comprising:

a first proximal guiding rib, formed in the lOL-folding stage to protrude into the proximal insertion channel.
12. The cartridge of claim 1.1, the lOL-folding stage comprising:

a fixed lOL-folding wing, to partially receive the IOL; and a foldable lOL-folding wing, to partially receive the IOL, wherein the first proximal guiding rib is formed in at least one of the fixed lOL-folding wing and the foldable lOL-folding wing.,
13. The cartridge of claim 12, wherein:

the fixed lOL-folding wing and the foldable lOL-folding wing form the proximal insertion channel when the foldable IOL-folding wing is attached to die fixed IOL-folding wing.

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14. The cartridge of claim 12, comprising:

a second proximal guiding rib, formed so that the fixed IO'L-folding wing and the foldable lOL-foiding. wing each have one of the first, proximal guiding rib and the second proximal guiding rib.
15. The cartridge of claim 11, wherein:

the first proximal guiding rib is configured to guide an edge of the IOL during an insertion of the IOL into an eye, thereby restraining a rotation of the IOL as it moves along the proximal insertion channel.
16. The cartridge of claim 11, wherein;

the first proximal guiding rib is configured to catch an edge ofthe IOL as part, of a folding of the IOL.
17. The cartridge of claim 11, comprising:

a first distal guiding rib, formed distal to the IOL folding stage,, to protrude into the distal insertion channel.
18. The cartridge of claim 17, wherein:

the first distal guiding rib is aligned with the first proximal guiding rib.

IS). The cartridge of claim 17, wherein:

the first distal guiding rib is not aligned with the first proximal guiding rib,
20. The cartridge of claim 17, wherein:

the first distal guiding rib is configured to guide an edge of the IOL during an K·¹ K·¹ ^r· K·' Mr· S·.· insertion of the IOL into an eye, thereby restraining a rotation of the IOL as it moves along the distal insertion channel.

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21. The cartridge of Claim 1, the lOL-guiding structure comprising:

one or more guiding grooves; and one or more guiding ribs.
22. An intraocular lens inserter, comprising:

an inserter cylinder;

a push-rod, partially in the inserter cylinder;

a cartridge-receiving insertion end, to receive a cartridge that includes an insertion nozzle, having a distal insertion channel;

an intraocular ophthalmic lens (IQL)-folding stage, to receive and to fold an 101.., proximal to the insertion nozzle, and having a proximal insertion channel; and an lOL-guiding structure.
23. The intraocular lens inserter of claim 22, the lO L-guiding structure comprising:

at least one of a guiding groove; and a guiding rib.